GAUTAM HOSPITAL AND RESEARCH CENTER
PSYCHOLOGICAL EVALUATION REPORT
(NOT VALID FOR MEDICO-LEGAL PURPOSES)
Name: Age: years Sex: F S. No.:
Marital Status: Single / Married / Remarried / Widowed / Divorced / Separated
Edu.: Illiterate / Primary Education / Secondary Education / Senior Secondary Education /
Graduate / Post Graduate / Professional Degree
Occ.: Housewife / Unemployed / Farmer / Business / Labor / Service / Student
Type of Family: Nuclear / Extended Nuclear / Joint / Living alone
Past H/O illness: Present / Absent
H/O Family Psychiatric Illness: Present / Absent H/O Sub. Abuse: Present / Absent
Personal History: Present / Absent Add.: Contact No.:
Test Administered: Y-BOCS Date: /2014
PRESENTING COMPLAINTS/CLINICAL FEATURES:
Lack of Satisfaction;
Repeated Thoughts About ;
Sadness;
Repeated Behavior of ;
Headache;
Restlessness; Palpitation;
Loss of interest;
Irritability;
Sleep disturbance;
Dizziness;
BRIEF HISTORY:
Client
TECHNICAL DETAILS:
Client was cooperative she answered to all the questions asked
and discussed about her problem in detail.
REPORT AND ADVICE:
Client is scoring in Obsession and in Compulsion. This
gives the total of out of 40 in obsessive compulsive rating
scale and puts the client in range of OCD severity.
Suggestive measures were given to the client to keep control over
her thoughts and behavior. Family members were also counseled
accordingly.
MANISHA SHARMA
(Clinical Psychologist) (Consultant Psychiatrist)